Provider Demographics
NPI:1861550261
Name:BRATCHER, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BRATCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 WARREN PKWY STE 324
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4095
Mailing Address - Country:US
Mailing Address - Phone:469-633-0550
Mailing Address - Fax:214-705-0529
Practice Address - Street 1:5575 WARREN PKWY STE 324
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4095
Practice Address - Country:US
Practice Address - Phone:469-633-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice